| NPI | 1427725837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA BURGESS Owner/ Administrator 866-974-6632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 253Z00000X In Home Supportive Care | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |